Endocarditis II: Clinical Features of Infective Endocarditis

Endocarditis can present various clinical features depending on the causative organism and the patient's underlying health conditions. Initially, the clinical features of infective endocarditis develop gradually, presenting with nonspecific symptoms that can be easily mistaken for other illnesses.

General Symptoms

Early symptoms of infective endocarditis are fever, chills, weakness, malaise, fatigue, and weight loss. These symptoms reflect the systemic nature of the infection and the body's inflammatory response to the bacterial presence in the bloodstream and heart tissue.

Vascular Signs

As the disease progresses, specific vascular signs become apparent. A notable feature is splinter hemorrhages—black, longitudinal streaks found under the nail beds. These are caused by small clots or fragments of infected material that embolize from the heart to the peripheral blood vessels.

Petechiae, small red or purple spots caused by minor hemorrhage, can appear in various locations, including the conjunctivae, lips, buccal mucosa, palate, ankles, feet, and antecubital and popliteal areas. These pinpoint hemorrhages indicate widespread microvascular involvement and can be a critical diagnostic clue.

Osler's nodes and Janeway lesions are hallmark signs of infective endocarditis. Osler's nodes are tender, red or purple, pea-sized lesions typically found on the fingertips or toes. They result from immune complex deposition in the skin. In contrast, Janeway lesions are non-tender, small, erythematous macules on the palms and soles caused by septic emboli. Roth's spots, which are hemorrhagic retinal lesions with pale centers, further underscore the systemic embolic phenomena associated with infective endocarditis.

Cardiac Manifestations

Cardiac involvement in infective endocarditis is significant and often includes the development of a new heart murmur or changes in an existing one. It occurs due to the infection causing damage to the heart valves, leading to turbulent blood flow that manifests as audible murmurs during cardiac auscultation. The presence of a new or changing heart murmur in the context of systemic infection strongly suggests infective endocarditis and warrants further investigation.